Besides a lack of health professionals in rural areas, there
are also fewer community resources, such as adult day care
centers where people with Alzheimer’s can go during the day for
care—and give their caregivers some respite. Many rural
communities are limited in fiscal resources and infrastructure
to develop their own community-based programs. And in recent
years, federal and state governmental support has been scaled
back. Caregivers themselves may find the cost of services is too
expensive and reimbursement policies are too restrictive.

Other obstacles caregivers face include a lack of
transportation and access to information or help.

Meanwhile, the flight of young people from these communities
leaves the burden to spouses, many of whom are old and suffering
from health problems themselves.

“The specific problems are the same for rural caregivers of
people with Alzheimer’s and other dementias, and other rural
caregivers: great distances that are involved, and the lack of
services,” Maslow said. “It’s difficult to get services to a
person in a rural area. The service provider has to travel a
long time or the caregiver has to travel. Some of the services
that we rely on in suburban and urban areas aren’t available and
can’t be used. In addition, rural areas are generally lower
income and [there are] fewer young people so [there is] more
difficulty for caregivers. There’s a lack of healthcare, medical
care and the kinds of community services people might need.”

Cultural Barriers

Even if primary care doctors and community services are
available, rural caregivers may not seek out this assistance.

A 2001 study, which appeared in the “Journal of Behavioral
Health Services and Research,” found that just a third of older
rural residents with memory problems associated with Alzheimer’s
asked their primary-care health provider for help. That compared
with half of their urban counterparts.

“The finding that rural inhabitants with memory impairments
were less likely to use a primary-care provider for their memory
problems is a public health concern, and we certainly need to
understand those barriers, which may include stigma, lack of
available transportation and denial,” according to Brenda Booth,
a University of Arkansas researcher and one of the article’s
co-authors.